Adjunctive intravitreal ceftazidime for syphilitic uveitis among people living with HIV: visual and inflammatory outcomes

Abstract Background Systemic penicillin is the standard treatment for syphilitic uveitis, yet the role of adjunctive intravitreal therapy in patients with substantial posterior-segment involvement is unclear. Comparative evidence for intravitreal ceftazidime is scarce. We evaluated its association with inflammatory and visual outcomes in people living with human immunodeficiency virus (HIV) receiving systemic penicillin. Methods In this retrospective individually matched cohort study, all 15 eligible patients who received systemic penicillin plus adjunctive intravitreal ceftazidime between January 2023 and June 2025 were matched 1:1 without replacement to contemporaneous patients treated with systemic penicillin alone, based on sex and age within 5 years. The primary outcome was change in vitreous haze grade from baseline to final follow-up. Secondary outcomes included change in best-corrected visual acuity (BCVA), expressed as the logarithm of the minimum angle of resolution (logMAR), at final follow-up and inflammatory outcomes at the end of intravenous treatment. Matched outcomes were analyzed using Wilcoxon signed-rank or exact McNemar tests. Results Thirty patients formed 15 matched pairs, with a median follow-up of 3.0 months in both groups. Median change in vitreous haze grade was − 3.00 with adjunctive treatment and − 2.00 with penicillin alone (paired Hodges–Lehmann difference, − 1.00 grade; 95% confidence interval [CI], − 1.25 to − 0.25; P = 0.003). Median change in logMAR BCVA was − 1.50 and − 0.30, respectively (paired difference, − 1.00; 95% CI, − 1.36 to − 0.60; Holm-adjusted P = 0.003). In contrast, early changes in vitreous haze and anterior chamber cell grades at the end of intravenous treatment did not differ significantly between groups. The final vitreous-haze and visual associations remained consistent in sensitivity analyses. No injection-related complication was documented among adjunctively treated patients. Conclusions Adjunctive intravitreal ceftazidime was associated with greater vitreous-haze clearance and visual recovery at final follow-up, but not with greater early inflammatory improvement at the end of intravenous treatment. These findings warrant prospective confirmation.